RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02088
BRANCH OF SERVICE:  Army	BOARD DATE:  20150121
SEPARATION DATE:  20060403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Services Operation) medically separated for right foot pain.  The right foot condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Chronic right foot pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “right foot pain” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20060307	VA – (~6 mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Foot Pain	5284	10%	Residuals, Fracture of Right Fifth Toe	5284	10%	20060921	
Other x 0  (Not in Scope)	Other x 2 	20060921	
Rating:  10%	Combined Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20061107 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Right Foot Pain.  In October 2003, the CI was injured when a mobile kitchen trailer rolled over his right foot.  He suffered a fracture of the proximal phalanx of his right 5th toe.  He was put into a short leg walking cast for 3 weeks.  When the cast came off, he used a cam walker boot for 11 weeks.  The CI was seen for follow-up on 25 May 2004.  His chief complaint at that time was pain in the right fourth toe.  He was given a steroid injection, which provided relief of pain.  He presented for care again on 14 June 2004, complaining of continued pain in the right foot with walking and running.  He was offered exploratory surgery, but he declined.  Due to the chronic, persistent nature of the right foot pain, a MEB was initiated.  The MEB narrative summary was dated on 5 December 2005.  Physical exam (PE) at that time was non-contributory.  The examiner’s diagnosis was: “chronic right foot pain.”  The CI was medically separated from service on 3 April 2006.  On 21 September 2006, 24 weeks later, the CI had a VA Compensation and Pension exam.  He reported that some days he could walk for long distances, but other days it was difficult to walk a city block.  There was no pain at the site of the previous fracture, but he complained of pain with pressure just above the right third and fourth toes.  On PE, both feet were normal in appearance.  Gait was normal and there were no limitations with standing or walking.  He was able to rise on his toes and heels.  There was no pain with motion of the right foot.  There was no edema (swelling), instability, or weakness.  The dorsum (sole) of the right foot was tender to pressure between the 3rd and 4th toes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both chose diagnostic code 5284 (Foot injuries, other) for the right foot condition, and both assigned a disability rating of 10%.  After careful review of all available evidence, the Board determined that, at the time of separation, the CI’s right foot condition was best described as “moderate.”  There was insufficient evidence in the record to justify a classification of “moderately severe” or “severe.”  The Board tried to find a path to a higher rating, using other VASRD codes for the right foot condition.  However, there was insufficient evidence of a significantly disabling foot abnormality that would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic right foot condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the right foot pain and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150010470 (PD201402088)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl			     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA